Prospective cohort study of laparoscopic and open hepatectomy for hepatocellular carcinoma.

Background The safety and feasibility of laparoscopic hepatectomy for hepatocellular carcinoma (HCC) with a diameter of 5 cm or less is well recognized. The role of laparoscopy in treating large HCC (5–10 cm) remains controversial. This prospective cohort study was undertaken to assess the short- and long-term outcomes of laparoscopic hepatectomy for large HCC and to compare this approach with open hepatectomy. Methods Patients with a solitary HCC (diameter 5–10 cm) who underwent open or laparoscopic hepatectomy were enrolled in a prospective observational study from January 2012 to April 2015. Perioperative and follow-up data were analysed. Results Some 128 patients underwent laparoscopic hepatectomy and 207 had an open hepatectomy. One and two perioperative deaths were reported in the laparoscopic and open groups respectively. Laparoscopic hepatectomy was converted to an open procedure in 12 (9·4 per cent) of 128 patients. More patients in the laparoscopic group underwent an anatomical hepatectomy than in the open group (45·3 versus 21·7 per cent; P = 0·001). The postoperative complication rate was 20·3 per cent for the laparoscopic group versus 35·7 per cent for the open group (P = 0·003). Mean(s.d.) duration of hospital stay was 11·4(3·1) and 15·8(7·7) days respectively (P < 0·001). One- and 3-year overall survival rates in the laparoscopic and open groups were 94·4 versus 93·6 per cent (P = 0·875), and 81·4 versus 82·2 per cent (P = 0·802), respectively. One- and 3-year disease-free survival rates were 89·4 versus 88·7 per cent (P = 0·825), and 67·3 versus 66·7 per cent (P = 0·902), respectively. Conclusion Laparoscopic hepatectomy is safe and feasible for the treatment of patients with large HCC.